Review of Helping Skills: Facilitating Exploration, Insight, and Action

Helping Skills is a textbook for learning broadly applicable counseling skills, presented in the context of a three-stage model comprising facilitation of exploration, insight, and action. This book, with discussion questions, written practice exercises, prompts for self-evaluation, and experiential “labs,” is ideally suited for a classroom setting. However, it could also serve to guide trainer- or self-directed group learning in other settings as well. It is clearly intended for those new to counseling and assumes no prior knowledge of the theories underlying the model. This review will focus on its usefulness as a guide to learning skills relevant to Motivational Interviewing.

The model as a whole and ethical issues in helping are presented first, followed by chapters regarding the skills that make up each stage in the helping process. Skills are presented individually, followed by discussion of how they may be integrated in practice. The exploration stage is most directly based on Rogerian/client-centered counseling and includes building rapport and identifying the problem. The insight stage is based on psychodynamic and interpersonal theories, and includes encouraging clients to recognize their role in their thoughts, feelings, and actions. Finally, the action stage is based on cognitive-behavioral theories, and includes helping clients initiate and maintain behavior change. Empathy is key to all three stages.

The skills of the exploration stage, with its basis in Rogerian counseling, are most directly applicable to MI. For those new to counseling, the detailed, step-by-step directions and exercises can be a reassuring resource in learning the “OARS” – open questions, affirmations, reflective listening, and summaries. For example, the author includes a 4-page chart of emotion names, and 16 possible sentence stems with which to begin a reflective statement. The author also explicitly addresses nonverbal skills in attending and listening, open questions, and reflections.

The insight stage has some similarities to the aim of developing discrepancy in MI, but the rationale and methods differ substantially. The skill of “challenge” as presented in this section bears some parallel to the use of double-sided reflections in MI, but the exercises would need to be placed in an MI context. Interpretation is rarely, if ever, used in MI, and self-disclosure is used differently enough, that the chapters devoted to these topics are unlikely to be useful to those learning counseling skills with the aim of applying them in MI.

The action stage bears significant parallels to Phase II Motivational Interviewing. The steps of the action stage include identifying a specific problem, exploring action, assessing previous attempts, making a commitment to change, brainstorming options, choosing an action option, in-session interventions (mostly cognitive-behavioral), choose tasks for outside the session, and check-in and modify assignments. Does that sound familiar? The author also warns of familiar traps such as moving too quickly to action, needing to be the expert, and getting stuck on one action idea. When applied in the “spirit” of MI, the exercises in this section can help beginning counselors learn to help clients commit to change.

Almost missing in this text is any discussion of resistance and how to respond to it. Furthermore, the chapters on giving feedback and information will seem very incomplete to those seeking guidance in developing those skills for use in MI practice.

The strengths of this text for general counseling training include its readability, its simply stated and integrative model, its reassuringly clear directions, and its extensive array of practice exercises. There are enough parallels between elements of the exploration/insight/action model and MI to make this text a useful resource for MI trainers and learners, but the exercises will need to be selected carefully, with a clear understanding of the spirit and principles of MI practice.

Deborah H. A. Van Horn, Ph. D. June 13, 2006